Three shunting procedure codes 33741, 33745 and 33746 are used for congenital cardiac anomalies and two new ventricular assist device codes are added previous year. The current codes for VAD are revised to incorporate the service for left heart. Each code has separate coding guidelines which need to be used for coding the shunt procedure. Since medical coders are going to use these codes frequently in surgery facility we are going to learn some coding tips for these codes.

Table of Contents

Description of shunting CPT code 33741, 33745, 33746

The physician performs a transcatheter atrial septostomy (TAS) by various methods to treat specific congenital cardiac anomalies, typically in infants = 4 kg. In one method, the physician makes a small incision in the arm or leg. Two catheters are placed: a central venous catheter and a second catheter threaded up to the heart. When the foramen ovale has not closed, a deflated balloon (Rashkind-type) is passed through the foramen ovale, inflated, and pulled through the atrial septum, enlarging the opening and improving oxygenation of the blood. When the septum is intact, the deflated balloon is passed from the right atrium through the septum to the left atrium, inflated, and withdrawn, creating an interatrial septal defect and improving oxygenation of the blood. The catheters are removed.

Pressure is placed over the incision for 20 to 30 minutes to stem bleeding and the patient is observed for a period afterward. The Park septostomy, or blade method, is an alternative to the Rashkind procedure, and is typically performed on infants older than 1 month of age. The physician makes a small incision in the femoral vein and places a transseptal sheath using standard methods, advancing the sheath to the superior vena cava under fluoroscopic or echocardiographic guidance.

Using a transseptal needle to cross the atrial septum, the left atrium is entered. The physician introduces a guidewire into the left atrium and removes the transseptal catheter while leaving the wire in place. A septostomy catheter is advanced over the wire into the left atrium. This catheter has a retracted blade, which the physician extends. The physician pulls the blade slowly across the atrial septum from the left into the right atrium, under fluoroscopic or echocardiographic guidance; several passes with the blade catheter may be made in this fashion.

The purpose of this procedure is to increase blood flow across the atrial septum in children with certain forms of cyanotic congenital heart disease. The physician removes the septostomy catheter and venous sheath. Pressure is placed over the incision for 20 to 30 minutes to stem bleeding. The patient is observed for a period afterward. This code includes the percutaneous access, placement of one or more access sheaths, advancement of the transcatheter delivery system, all imaging guidance that is performed, and the creation of effective intracardiac atrial blood flow.

33741 Transcatheter atrial septostomy (TAS) for congenital cardiac anomalies to create effective atrial flow, including all imaging guidance by the proceduralist, when performed, any method (eg, Rashkind, Sang-Park, balloon, cutting balloon, blade)
(Do not report modifier 63 in conjunction with 33741)

CPT code 33741 is added to report the transcatheter atrial septostomy (TAS) procedure for congenital anomalies. The procedure involves the percutaneous creation of improved atrial blood flow by any methods such as balloon/blade. The procedure also includes imaging guidance when performed

The physician treats various congenital cardiac anomalies by placing one or more intracardiac stents to create a shunt that allows for more effective intracardiac blood flow. Under imaging guidance, the physician uses a transcatheter approach to place one or more stents in the same location in 33745. Included in the procedure is intracardiac stent placement, balloon angioplasty of the target zone before or after stent placement, and, when performed, all ultrasound guidance for vascular access, fluoroscopic guidance for the intervention, and complete diagnostic right and left heart catheterization. CPT code 33746 is reported if additional, different intracardiac locations are treated with stents during the same session.

CPT code 33745 is added to report intracardiac shunt creation using a stent for effective intracardiac flow. The procedure includes stent placement, target zone angioplasty, diagnostic cardiac catheterization and imaging guidance when performed.

CPT code 33746 is used to describe each additional intracardiac shunt creation by stent placement at a separate location during the same session as the primary intervention (33745).

33745 Transcatheter intracardiac shunt (TIS) creation by stent placement for congenital cardiac anomalies to establish effective intracardiac flow, including all imaging guidance by the proceduralist, when performed, left and right heart diagnostic cardiac catherization for congenital cardiac anomalies, and target zone angioplasty, when performed (eg, atrial septum, Fontan fenestration, right ventricular outflow tract, Mustard/Senning/Warden baffles); initial intracardiac shunt

+33746 each additional intracardiac shunt location (List separately in addition to code for primary procedure)

Deleted CPT codes in 2021

CPT codes 92992 and 92993 are deleted in 2021. CPT codes 92992 and 92993 from medicine section werer used to report for the septostomy procedures. CPT 92992 was used to report septostomy procedure by balloon method (eg, Rashkind type) and CPT 92993 was used to report septostomy procedure by blade method (Park septostomy). From 2021, these two codes are deleted.

Revised CPT codes for Ventricular assist device VAD

CPT Code 33990 and 33991 are revised to specify the procedure that involves the left heart and code 33992 is revised to report the removal of VAD from the left heart.

Now CPT Code 33993 is revised to report the repositioning of right or left VAD at separate and distinct session from insertion.

33990: Insertion of ventricular assist device, percutaneous including radiological supervision and interpretation; left heart, arterial access only

33991: Insertion of ventricular assist device, percutaneous including radiological supervision and interpretation; left heart, both arterial and venous access, with transseptal puncture

33992: Removal of percutaneous left heart ventricular assist device, arterial or arterial and venous cannula(s), separate and distinct session from insertion

33993: Repositioning of percutaneous right or left heart ventricular assist device, with imaging guidance, at separate and distinct session from insertion

CPT codes for Ventricular assist device VAD

New CPT code 33995 is used to report the insertion of ventricular assist device in the right heart and new code 33997 is used to report the removal of ventricular assist device from the right heart at a separate and distinct session from the VAD insertion.

33995: Insertion of ventricular assist device, percutaneous, including radiological supervision and interpretation; right heart, venous access only

33997: Removal of percutaneous right heart ventricular assist device, venous cannula, separate and distinct session from insertion

Do and Don’t with CPT code 33741, 33745 & 33746

Code 33741 includes percutaneous access, placing the access sheath(s), advancement of the transcatheter delivery system, and creation of effective intracardiac atrial blood flow. Codes 33741, 33745 include, when performed, ultrasound guidance for vascular access and fluoroscopic guidance for the intervention. Code 33745 additionally includes intracardiac stent placement, target zone angioplasty preceding or after stent implantation, and complete diagnostic right and left heart catheterization, when performed.

Codes 33741, 33745 are typically used to report creation of effective intracardiac blood flow in the setting of congenital heart defects. Code 33741 (transcatheter atrial septostomy) involves the percutaneous creation of improved atrial blood flow (eg, balloon/blade method), typically in infants

Diagnostic cardiac catheterization is not typically performed at the same session as transcatheter atrial septostomy (CPT code 33741) and, when performed, may be separately reported. Diagnostic cardiac catheterization is typically performed at the same session with 33745 and the code descriptor includes this work, when performed.

CPT Code 33745, 33746 are used to describe intracardiac stent placement. Multiple stents placed in a single location may only be reported with a single code. When additional, different intracardiac locations are treated in the same session, 33746 may be reported. Codes 33745, 33746 include all balloon angioplasty(ies) performed in the target lesion, including any pre-dilation (whether performed as a primary or secondary dilation), post-dilation following stent placement, or use of larger/smaller balloon, to achieve therapeutic result. Angioplasty in a separate and distinct intracardiac lesion may be reported separately. Use 33746 in conjunction with 33745.

Additional Code Information for CPT code 33741, 33745 & 33746

PC/TC Indicator (26):0 = Physician Service Codes

Multiple Procedures (51):2 = Standard payment adjustment rules for multiple procedures apply

Bilateral Surgery (50):0 = 150% payment adjustment for bilateral procedures does not apply

Physician Supervision:09 = Concept does not apply

Assistant Surgeon (80,82):2 = Payment restriction for assistants at surgery does not apply to this procedure

Co-Surgeons (62):0 = Co-surgeons not permitted for this procedure

Team Surgery (66):0 = Team surgeons not permitted for this procedure

Diagnostic Imaging Family:99 = Concept does not apply

RVUs and Fees for CPT code 33741

Non-Facility	Work	MP	PE	RVU	Total
Non-Facility	14.00	3.17	4.77	21.94	N/A
Facility	Work	MP	PE	RVU	Total
Facility	14.00	3.17	4.77	21.94	$743.49

RVUs and Fees for CPT code 33745

Non-Facility	Work	MP	PE	RVU	Total
Non-Facility	20.00	4.51	6.82	31.33	N/A
Facility	Work	MP	PE	RVU	Total
Facility	20.00	4.51	6.82	31.33	$1,061.69

RVUs and Fees for CPT code 33746

Non-Facility	Work	MP	PE	RVU	Total
Non-Facility	8.00	1.79	2.73	12.52	N/A
Facility	Work	MP	PE	RVU	Total
Facility	8.00	1.79	2.73	12.52	$424.27

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CPT code 33741, 33745 & 33746: Shunt Coding Guidelines